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Box 11-2. Personalized management of asthma in children 5 years and younger GINA 2026 Children 5 years and younger Exclude alternative diagnoses Personalized asthma Symptom control & modifiable risk factors Comorbidities management: Symptoms Inhaler technique & adherence Assess, Adjust, Review response Exacerbations Child and parent/caregiver preferences and goals Side-effects Comorbidities Lung function REVIEW Treatment of modifiable risk factors and comorbidities Child and parent/caregiver satisfaction Non-pharmacological strategies Asthma medications DONOT COPY ADJUST Education & skills training Asthma medication options: STEP 4 Adjust treatment up and down for individual child's needs STEP 3 Continue controller STEP 2 & refer for expert Double 'low dose' ICS STEP 1 assessment PREFERRED (Insufficient Daily low dose inhaled corticosteroid (ICS) (See Box 11-3) CONTROLLER (see Box 11-3 for ICS dose ranges for preschool children) CHOICE evidence for daily controller) Other controller options Consider intermittent Daily leukotriene receptor antagonist Consider referral for (limited indications, or short course ICS at or intermittent short course of ICS at onset of expert assessment less evidence for efficacy onset of viral illness respiratory illness or safety) RELIEVER COPY As-needed short-acting CONSIDER Infrequent acute THIS STEP FOR Asthma symptoms not well-controlled (Box 11-1), Asthma not well Asthma not well (e.g. viral-induced) or one or more severe exacerbations in the past year controlled on controlled on CHILDREN WITH: wheezing episodes low dose ICS Step 3 ICS and no or minimal interval asthma Before stepping up, check for alternative diagnosis symptoms and inhaler skills, review adherence and exposures ICS: inhaled corticosteroid; LTRA: leukotriene receptor antagonist. For ICS doses in children, see Box 11-3 (p.208) prescribing LTRA, advise parent/caregiver about risk of neuropsychiatric adverse effects. 11. Assessment and management (children 5 years and younger) 207